MR仿真结肠镜诊断结直肠癌的价值

 目的 评价MR仿真结肠镜对结直肠癌的显示能力和临床应用价值.方法 手术病理证实的结直肠癌患者35例行MRVC.肠道准备后,经肛管注入结肠1:100的钆喷酸葡胺水溶液约1 300～1 800 ml,被检查者取俯卧位和仰卧位进行以下扫描:(1)True-FISP序列扫描;(2)3D-FLASH序列扫描;(3)若发现病变,可加扫常规二维FLASH /TSE脉冲序列.将3D-FLASH容积扫描数据传输到工作站进行仿真内窥镜(MRVE)、容积再现的半透明(MR-VRSV)、多平面重建(MPR)等后处理.比较其MRVC和电子光学结肠镜,分析以下3方面征象:(1)肿瘤检出率;(2)肿瘤环肠周程度;(3)肿瘤分型.结果 MRVC检出37/38个恶性病变(97.4%),电子光学结肠镜检出34/38个恶性病变(89.5%)(χ2=0.856,P=0.355).MRVC不仅对结直肠癌环肠周程度和分型的显示与电子光学结肠镜及手术病理结果具有良好的一致性,还能更好的显示结直肠癌的周围侵犯及远处转移情况.结论 MRVC可清楚显示结直肠癌病灶,明确其数目、环肠周程度和分型,有助于确定肿瘤分期和制定治疗方案,有具有较高的临床应用价值.

MR virtual colonoscopy in diagnosis of colorectal carcinomas

Objective To evaluate the performance and clinical use value of MR virtual colonoscopy (MRVC) in colorectal carcinoma. Methods MRVC was performed on 35 patients with colorectal carcinomas. After bowel preparation,1 300 - 1 800 ml enema (2000 ml of water added with 20 ml Gd - DTPA) was given through the rectum into the colon. Then scans were performed on the subjects in prone and supine positions:(1) true - FISP sequence, (2) 3D - FLASH sequence,(3) when colon lesions were found, the 2D - FLASH/TSE was added. The 3D - FLASH data were transferred to the diagnostic workstation.MRVE, MR-VRSV and MPR images were acquired. MRVC were compared with electronic colonoscopy in lesions detecting rate, circumferential extension and pathologic pattern.Results The detecting rates of MRVC and electronic colonoscopy were 97.4%(37/38) and 89.5%(34/38) , respectively (x2=0.856, P = 0.355) . MRVC not only accorded with electronic colonoscopy in demonstrating the circumferential extension and pathologic pattern of colorectal carcinoma, but also depicted the infiltrating range of the tumor and the distant metastasis. Conclusions MRVC is reliable in preoperative diagnosis, demonstrating the number, circumferential extension and pathologic pattern, and is effective in staging and treatment planning of colorectal carcinoma; it has an important value in clinic application.